Daily amplitudes of air temperature in Zagreb, Croatia

U svim mjesecima aperiodička amplituda je veća od periodičke. Amplitude su veće na periferiji nego u centru grada. Amplitude su manje na većoj nadmorskoj visini. U razdoblju 1953.-1983. aperiodička amplituda je u godišnjem prosjeku pala u Podsusedu za 0,3˚, a na Griču za 0,6˚. Aperiodička amplituda u studenom je u Podsusedu porasla za 2,1˚, a na Griču za 0,8˚. Srpanjska aperiodička amplituda u Podsusedu porasla je za 0,2˚, a na Griču za 0,4˚.In all months aperiodic amplitude is greater than periodic one. The amplitudes are much greateron the periphery than in the central area. The amplitudes are smaller on the higher altitude. In the period 1953-1983 one reveals that annual aperiodic daily amplitude in Podsused are 0,3˚, and in Grič 0,6˚ lower than at the beginning of the period. In November the aperiodic amplitude is 2,1˚ greater, and in Grič only 0,8˚ greater than at the beginning of analysed period. The mean July aperiodic amplitude in Podsused is 0,2˚ greater, and 0,4˚ greater in Gričthan at the beginning of the analysed period

Study protocol for VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer, a UK multicentre randomised controlled trial with an internal pilot (the VIOLET study)

INTRODUCTION: Lung cancer is a leading cause of cancer deaths worldwide and surgery remains the main treatment for early stage disease. Prior to the introduction of video-assisted thoracoscopic surgery (VATS), lung resection for cancer was undertaken through an open thoracotomy. To date, the evidence base supporting the different surgical approaches is based on non-randomised studies, small randomised trials and is focused mainly on short-term in-hospital outcomes. METHODS AND ANALYSIS: The VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer study is a UK multicentre parallel group randomised controlled trial (RCT) with blinding of outcome assessors and participants (to hospital discharge) comparing the effectiveness, cost-effectiveness and acceptability of VATS lobectomy versus open lobectomy for treatment of lung cancer. We will test the hypothesis that VATS lobectomy is superior to open lobectomy with respect to self-reported physical function 5 weeks after randomisation (approximately 1 month after surgery). Secondary outcomes include assessment of efficacy (hospital stay, pain, proportion and time to uptake of chemotherapy), measures of safety (adverse health events), oncological outcomes (proportion of patients upstaged to pathologic N2 (pN2) disease and disease-free survival), overall survival and health related quality of life to 1 year. The QuinteT Recruitment Intervention is integrated into the trial to optimise recruitment. ETHICS AND DISSEMINATION: This trial has been approved by the UK (Dulwich) National Research Ethics Service Committee London. Findings will be written-up as methodology papers for conference presentation, and publication in peer-reviewed journals. Many aspects of the feasibility work will inform surgical RCTs in general and these will be reported at methodology meetings. We will also link with lung cancer clinical studies groups. The patient and public involvement group that works with the Respiratory Biomedical Research Unit at the Brompton Hospital will help identify how we can best publicise the findings

A randomised trial of near infra-red spectroscopy for the personalised optimisation of cerebral tissue oxygenation during cardiac surgery

Background We assessed whether a Near Infra-Red Spectroscopy (NIRS) based algorithm for the personalised optimisation of cerebral oxygenation during cardiopulmonary bypass (CPB) combined with a restrictive red cell transfusion threshold would reduce perioperative injury to the brain, heart and kidneys. Methods In a randomised controlled trial participants in 3 UK centres were randomised with concealed allocation to a NIRS (INVOS 5100, Medtronic Inc, MN, USA) based ‘patient-specific’ algorithm that included a restrictive red cell transfusion threshold (haematocrit 18%), or to a ‘generic’ non NIRS based algorithm (standard care). The NIRS algorithm aimed to maintain cerebral oxygenation at an absolute value of &gt;50% or, &gt;70% of baseline values. The primary outcome for the trial was cognitive function measured up to 3 months post-surgery. Results The analysis population comprised eligible randomised patients that underwent valve or combined valve surgery and coronary artery bypass grafts (CABG) using cardiopulmonary bypass between December 2009 and January 2014 (n=98 patient-specific algorithm; N=106 generic algorithm). There was no difference between the groups for the 3 core cognitive domains; attention, verbal memory, and motor coordination, or for the non-core domains psychometer speed and visuo-spatial skills. The NIRS group had higher scores for verbal fluency; Mean Difference 3.73, 95% CI (1.50, 5.96). Red cell transfusions, biomarkers of brain, kidney and myocardial injury, adverse events and healthcare costs were similar between the groups. Conclusions These results do not support the use of NIRS based algorithms for the personalised optimisation of cerebral oxygenation in adult cardiac surgery. </p

Video-assisted thoracoscopic or open lobectomy in early-stage lung cancer

Background There is limited randomized evidence on the comparative outcomes of early-stage lung cancer resection by video-assisted thoracoscopic surgery (VATS) versus open resection. Methods We conducted a parallel-group multicenter randomized trial that recruited participants with known or suspected early-stage lung cancer and randomly assigned them to open or VATS resection of their lesions. The primary outcome was physical function at 5 weeks as a measure of recovery using the European Organisation for Research and Treatment of Cancer core health-related quality of life questionnaire (QLQ-C30) (scores range from 0 to 100, with higher scores indicating better function; the clinical minimally important difference for improvement is 5 points). We followed the patients for an additional 47 weeks for other outcomes. Results A total of 503 participants were randomly assigned (247 to VATS and 256 to open lobectomy). At 5 weeks, median physical function was 73 in the VATS group and 67 in the open surgery group, with a mean difference of 4.65 points (95% confidence interval, 1.69 to 7.61). Of the participants allocated to VATS, 30.7% had serious adverse events after discharge compared with 37.8% of those allocated to open surgery (risk ratio, 0.81 [95% confidence interval, 0.66 to 1.00]). At 52 weeks, there were no differences in cancer progression-free survival (hazard ratio, 0.74 [0.43 to 1.27]) or overall survival (hazard ratio, 0.67 [0.32 to 1.40]). Comclusions VATS lobectomy for lung cancer is associated with a better recovery of physical function in the 5 weeks after random assignment compared with open surgery. Long-term oncologic outcomes will require continued follow-up to assess. (Funded by the National Institute for Health Research Health Technology Assessment programme [reference number 13/04/03]; ISRCTN number, ISRCTN13472721.

Warm versus cold blood cardioplegia in paediatric congenital heart surgery:a randomized trial

OBJECTIVES:Intermittent cold blood cardioplegia is commonly used in children, whereas intermittent warm blood cardioplegia is widely used in adults. We aimed to compare clinical and biochemical outcomes with these 2 methods.METHODS:A single-centre, randomized controlled trial was conducted to compare the effectiveness of warm (≥34°C) versus cold (4–6°C) antegrade cardioplegia in children. The primary outcome was cardiac troponin T over the 1st 48 postoperative hours. Intensive care teams were blinded to group allocation. Outcomes were compared by intention-to-treat using linear mixed-effects, logistic or Cox regression.RESULTS:97 participants with median age of 1.2 years were randomized (49 to warm, 48 to cold cardioplegia); 59 participants (61%) had a risk-adjusted congenital heart surgery score of 3 or above. There were no deaths and 92 participants were followed to 3-months. Troponin release was similar in both groups [geometric mean ratio 1.07; 95% confidence interval (CI) 0.79–1.44; P = 0.66], as were other cardiac function measures (echocardiography, arterial and venous blood gases, vasoactive-inotrope score, arrhythmias). Intensive care stay was on average 14.6 h longer in the warm group (hazard ratio 0.52; 95% CI 0.34–0.79; P = 0.003), with a trend towards longer overall hospital stays (hazard ratio 0.66; 95% CI 0.43–1.02; P = 0.060) compared with the cold group. This could be related to more unplanned reoperations on bypass in the warm group compared to cold group (3 vs 1).CONCLUSIONS:Warm blood cardioplegia is a safe and reproducible technique but does not provide superior myocardial protection in paediatric heart surgery